Literature Review

‘Think like a reviewer’: How hospices can use communication, documentation to boost quality McKnights Home Care; by Adam Healy; 9/24/24 Regulators are tightening their scrutiny of the hospice industry, so providers must prioritize the documentation and communication practices that help them obtain higher quality scores. That’s according to hospice industry experts who spoke during an educational session at the National Hospice and Palliative Care Organization’s annual meeting in Denver. “They’re looking closely at the hospice industry,” Angela Huff, senior managing consultant at Forvis Mazars, said last week during the conference. “They have increasing concerns about fraud, waste and abuse in this space. … Don’t think this is going to stop.” ... A key part of hospice quality assurance is communication, Gallarneau said. Providers should support open, friendly channels of communication. This helps staff and clients feel comfortable raising concerns, making quality issues easier to tackle quickly and effectively. Also, prioritizing accuracy in documentation will help providers stay ready for any surveys or audits, Gallarneau noted. Hospices should ensure patient consent and election of benefit forms are properly filled out, signed and dated, and staff should all be trained to do so accordingly. 

Cigna to cut Medicare Advantage plans in several statesModern Healthcare; by Lauren Berryman; 9/19/24Cigna Group's health insurance unit is scaling back Medicare Advantage offerings in eight states next year, according to a notice to third-party marketers published by the insurance brokerage Pinnacle Financial Services. Members in 36 health plans will be affected by Cigna Healthcare’s cuts and service area reductions in Colorado, Florida, Illinois, Missouri, North Carolina, Tennessee, Texas and Utah. Most people will have another Cigna Medicare Advantage plan available in their counties. The company's Medicare Advantage business is fully exiting at least three counties: two in Missouri and one in North Carolina, the notice said.

New red flags emerge in hospice UPIC auditing Hospice News; by Holly Vossel; 9/20/24 Unified Program Integrity Contractor (UPIC) auditors are taking a sharper look at nursing home room-and-board for hospice patients. Hospices have increasingly faced more regulatory scrutiny in recent years amid rising program integrity concerns, including ramped up UPIC audits, among various others. These audits are designed to instill oversight measures aimed at safeguarding against bad actors in the hospice industry. Regulators have been zeroing in around hospices’ data when it comes to patient interviews and Medicaid skilled nursing room-and-board payments, among other aspects of care delivery. These data could give UPIC auditors clues as to potential malfeasance. However, auditors’ data extrapolation methodology is flawed and poses risks for quality hospice providers, according to Bryan Nowicki, partner at the law firm Husch Blackwell.

How palliative care-ACO partnerships could reduce health disparities Hospice News; by Holly Vossel; 9/18/24 Palliative care providers engaging in Accountable Care Organization (ACO) relationships have the potential to make significant strides in bridging inequitable gaps of access. Groups of physicians, hospitals and other health care providers voluntarily join forces in ACOs, which are designed to offer high-quality, coordinated care to Medicare patients. Collaborating or contracting with ACO networks can help palliative care providers better understand and address the leading barriers among underserved populations as they move across the continuum, said Empath Health CEO Jonathan Fleece. The ACO reimbursement landscape includes incentives and quality measures designed to improve outcomes based on population needs. Providing palliative care through ACO relationships can result in greater potential to address patients’ full scope of medical, non-medical and psychosocial needs further upstream in their illness trajectories, Fleece stated, speaking at the recent Hospice News Palliative Care Virtual Summit.

CMS updates guidance for rural emergency hospitals: 16 things to know Becker's Hospital CFO Report; by Alan Condon; 9/17/24 CMS has updated guidance for hospitals interested in converting to a rural emergency hospital, a Medicare designation that was made available Jan. 1, 2023. REHs are a provider type established by the Consolidated Appropriations Act, 2021, to address concerns over rural hospital closures and provide rural facilities a potential alternative to closure.  Since 2005, 106 rural hospitals have shut down, with another 86 facilities no longer providing inpatient services, according to data compiled by the University of North Carolina's Cecil G. Sheps Center for Health Services Research. Of those, 37 closures have occurred since 2020. Here are 16 things to know about REHs, including designation requirements, qualifying facilities, conditions of participation and how many hospitals have converted to REHs.  

CMS submits 75,000 pages to federal court to justify nursing home staffing mandate McKnights Long-Term Care News; by Kimberly Marselas; 9/15/24 The Department of Health and Human Services filed more than 75,000 pages of rule-making records with a federal court Friday, beginning its formal defense of its controversial nursing home staffing mandate. The submission of the administrative record is the first significant advance in the case since the American Health Care Association brought its challenge to the minimum staffing standard in late May. The Texas Health Care Association, three Texas providers and LeadingAge are also part of the case. In another development, District Court for the Northern District of Texas Judge Matthew Kacsmaryk on Sept. 10 agreed to fold in a separate federal challenge against the staffing mandate filed by the state of Texas. He noted that the two cases “share common questions of law or fact, consist of similar parties, the same claims, and [have] the same relief sought.”

Hospices improving on public measures Home Health Line - decisionhealth; by DecisionHealth Staff; 9/12/24 Hospice providers are seeing continued improvement on key measures in the Hospice Item Set, according to the latest refresh of Care Compare data on Aug. 28, 2024. [Subscription required] Editor's note: Use this summary information to check your own CMS Hospice Compare Scores at Find Healthcare Providers: Compare Care Near You | Medicare. Select Provider Type "Hospice Care." Type your location or "Name of Agency" and "Search." Select your hospice. For the Hospice Item Set (HIS), scroll down to "Quality" - "Quality of patient care." For your CAHPS data, scroll down to "Family caregiver experience."

Frailty in Medicare Advantage beneficiaries and Traditional Medicare beneficiariesJAMA Network Open; Sandra M. Shi, MD, MPH; Brianne Olivieri-Mui, PhD, MPH; Chan Mi Park, MD, MPH; Stephanie Sison, MD, MBA; Ellen P. McCarthy, PhD, MPH; Dae H. Kim, MD, ScD; 8/24In this nationally representative cohort study of 7063 community-dwelling individuals aged 65 years and older, compared with traditional fee-for-service Medicare beneficiaries, Medicare Advantage beneficiaries had higher levels of frailty at baseline but similar levels of frailty change over 1 year. These findings suggest that enrollment in Medicare Advantage plans is not associated with altered frailty trajectories compared with Traditional Medicare, and more work is needed to better understand the health services needs of older adults with frailty.

Medicare Advantage bonus payments decline for first time since 2015Becker's Payer Issues; by Rylee Wilson; 9/11/24Bonus payments to Medicare Advantage plans will decline by around 8% in 2024 compared to 2023, according to a report from KFF. The analysis, published Sept. 11, found bonus payments to MA plans will decline by around $1 billion to $11.8 billion in 2024. Although this was the first decline since 2015, the $11.8 billion in payments will still exceed amounts for every year from 2015 to 2022. The number of bonus payments will decline because of temporary policies in place during the COVID-19 pandemic increased star ratings for some plans, according to KFF. When the policies ended, some plans took a hit in bonus payments. CMS pays Medicare Advantage plans bonus payments for achieving a star rating of four or higher.

Hospitals target Medicare Advantage in DSH payment lawsuitModern Healthcare; by Alex Kacik; 9/11/24Hospitals allege in a new lawsuit that the federal government unlawfully changed Medicare disproportionate share hospital payment calculations to include care provided to Medicare Advantage patients, and facilities lost billions of dollars in the process. Eighty hospitals on Monday sued the Health and Human Services Department over how the agency factors inpatient care for Medicare Advantage patients into DSH payments, which are meant to bolster providers that treat many low-income patients. Hospitals from states including California, Ohio, Pennsylvania and Texas allege HHS violated the Administrative Procedure Act by not following the typical rulemaking process when it finalized a rule in June 2023 on how Medicare Advantage influences DSH calculations.

Medicare administrative contractor news includes a data breach and potential consolidation HFMA, Downers Grove, IL; by Nick Hut; 9/9/24 Recent happenings involving Medicare administrative contractors (MACs) include a notice of a data breach and a request for feedback on possible consolidation. CMS sent out word that nearly 950,000 Medicare beneficiaries whose claims go through Wisconsin Physicians Service Insurance Corporation (WPS) are being informed that their protected health information or other personally identifiable information may have been compromised due to a security vulnerability in third-party software. The breach also could have affected those with other insurance if their information was collected to support CMS’s audits of healthcare providers, according to a news release. Belying its name, WPS handles Medicare Parts A and B claims spanning Indiana, Iowa, Kansas, Michigan, Missouri and Nebraska (not Wisconsin). 

CMS to expand ‘enhanced oversight’ to combat hospice fraud in 4 states Hospice News; by Jim Parker; 9/10/24 The U.S. Centers for Medicare & Medicaid Services (CMS) is expanding its enhanced oversight for new hospices in fraud-ridden states, including California, Nevada, Arizona and Texas. The agency in July 2023 first announced a “provisional period of enhanced oversight” for new hospices in those states. A key component of the enhanced oversight includes a medical review of claims before a Medicare Administrative Contractor (MAC) will pay them. “To combat fraud, waste, and abuse under the hospice benefit, CMS will expand prepayment medical review this September in Arizona, California, Nevada and Texas,” the agency indicated in a statement. “To help reduce burden on compliant providers, initial review volumes will be low and adjusted based on results. If you’re noncompliant, we may implement extended review or take additional administrative actions.” 

Norfolk woman celebrates 106th birthday after hospice discharge for being too healthy CBS WTKR 3, Norfolk, VA; by Vashti Moore; 9/6/24 A local woman not only celebrated good health on Thursday, but she also celebrated 106 years of life. Dorothy Southall was born in Whaleyville — a small neighborhood in Suffolk on Sept. 5, 1918. That’s two years before women received the right to vote and two months before the end of World War I. ... During the Civil Rights Movement, Dorothy worked as a licensed practical nurse at Bellevue Hospital Center in New York. She served her community as a healthcare worker for 20 years before moving back to Virginia in the late 1980s where she would live on her own and manage her own finances until she was 103. ... In August 2023, while living with her family, Dorothy was discharged from hospice because she deemed too healthy and no longer met the requirements. When admitted into residential care this summer in Norfolk, Dorothy said she “felt like she was home” when she arrived.